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NPI Code Detail

MEDICARE: KRYSTAL A COFFMAN NP

MEDICARE: KRYSTAL A COFFMAN NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner152405NC
2363LA2100XAcute Care Nurse PractitionerAPN001430NV

General Provider Information

NPI Number : 1427091438
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRYSTAL A COFFMAN NP
Provider Business Mailing Address
First Line : 5400 S RAINBOW BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-1859
Country : US
Telephone Number : 702-853-3000
Fax Number :
Provider Business Practice Location Address
First Line : 5400 S RAINBOW BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-1859
Country : US
Telephone Number : 702-853-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2006
Last Update Date : 10/05/2012

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